P1696: ECONOMIC BURDEN IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) FOR PATIENTS WITH ≥2 PRIOR LINES OF THERAPY INCLUDING A BRUTON TYROSINE KINASE INHIBITOR (BTKI) AND/OR B-CELL LYMPHOMA 2 INHIBITOR (BCL2I)
Authors: Masoom Priyadarshini, Gaurav Deshpande, Simran K Tiwana, T. Kim Le, Sean Garrison, Farrukh Awan
Journal: HemaSphere (2023)

Topic: 36. Ethics and health economics Background: The CLL/SLL (CLL) treatment landscape in the United States (US) has evolved in recent years with the introduction of targeted therapies, such as BTKis and BCL2is. Real-world evidence focusing on economic burden among pts with CLL who have failed these targeted therapies is limited. Aims: To assess health care resource utilization (HCRU) and costs among pts with CLL who received ≥2 prior lines of therapy (LOT), including a BTKi and/or BCL2i, and started a subsequent LOT. Methods: This retrospective study used the IQVIA PharMetrics Plus claims data (01/01/2011–04/30/2022). Study population included US adult pts (≥18 y of age) diagnosed with CLL (ICD-9-CM: 204.1x or ICD-10-CM: C91.1x, C83.0x) who received ≥2 prior LOTs, including a BTKi (Cohort 1) or both a BTKi and BCL2i (Cohort 2), and started a subsequent LOT. For Cohort 1, index date was defined as the start of ≥3 LOTs after discontinuation of a BTKi. For Cohort 2, index date was defined as the start of ≥3 LOTs after discontinuation of a BTKi and a BCL2i. Pts had to be continuously enrolled for ≥6 mo before the index date during which all other primary cancers (except nonmelanoma skin cancer) were excluded and for ≥1 mo postindex. Pt characteristics, treatment patterns, HCRU (office, hospital/facility outpatient, other outpatient [telehealth, testing facility, etc], inpatient, and emergency room [ER] visits), and health care costs were summarized descriptively. HCRU and costs were estimated in the follow-up period as CLL related and all-cause per patient per month (PPPM) after excluding the top and bottom 2.5% outliers. All costs were adjusted to 2021 US dollars. Results: The study cohort included 166 pts in Cohort 1 and 20 pts in Cohort 2, with a median follow-up of 14.1 and 9.6 mo, respectively. Pts in Cohorts 1 and 2, respectively, had a mean age of 66.5 and 62.6 y, were mostly male (68.7% and 80.0%), had a mean Charlson Comorbidity Index (excluding cancer) score of 1.5 and 1.2, and had a median of 2 prior LOTs. The most common regimens observed in the index LOT were BCL2i + anti-CD20 monoclonal antibody (mAb [22.3%]), BTKi monotherapy (19.3%), chemotherapy + anti-CD20 mAb (16.3%), and BCL2i monotherapy (12.7%). In Cohorts 1 and 2, respectively, all pts had an all-cause outpatient visit, 56.3% and 50.0% had ≥1 inpatient admission, and 39.2% and 15.0% had ≥1 ER visit. Mean all-cause PPPM HCRU outcomes in Cohorts 1 and 2 were as follows: office visits (2.1 and 2.3), hospital/facility outpatient visits (2.4 and 2.1), ER visits (0.1 and 0), inpatient stays (0.1 and 0.1), and other outpatient visits (3.8 and 3.0). Total all-cause health care mean (standard deviation) cost PPPM was $17,615 ($17,980) for Cohort 1 and $18,948 ($15,098) for Cohort 2. The main drivers of all-cause PPPM total costs in Cohorts 1 and 2, respectively, were drug costs ($11,392 and $14,323) followed by inpatient costs ($4194 and $2794), outpatient costs ($1907 and $1819), and ER costs ($122 and $12). CLL-related HCRU and costs are shown in the Figure. CLL-related PPPM costs accounted for 86% and 90% of the total health care costs in Cohorts 1 and 2, respectively (Figure). Summary/Conclusion: This study demonstrated that pts with CLL in the ≥3 LOTs who received prior BTKi and/or BCL2i experienced a high economic burden. Drug cost was the major driver and accounted for 65% and 76% of the total health care expenditure across Cohorts 1 and 2, respectively. Despite the small sample size of Cohort 2, a trend towards higher PPPM cost was observed. Future studies with larger sample sizes should further strengthen findings from this study.Keywords: Health care, Venetoclax, Cost analysis, Chronic lymphocytic leukemia